CONGENITAL CATARACT TREATMENTS

For congenital cataracts that cause no symptoms or only minor visual changes, no treatment may be necessary. Continued monitoring and assessment of the congenital cataract is needed by an ophthalmologist or optometrist at scheduled office visits. Increased strength in prescription eyeglasses or contact lenses may be helpful. This may be all that is required if the congenital cataract does not reduce the patient's quality of life.

Congenital Cataract surgery--the only option for patients whose congenital cataracts interfere with vision to the extent of affecting their daily lives--is the most frequently performed surgery in the United States. It generally improves vision in over 90% of patients. Some people have heard that a congenital cataract should be "ripe" before being removed. A "ripe" or mature congenital cataract is when the lens is completely opaque. Most congenital cataracts are removed before they reach that stage. Sometimes congenital cataracts need to be removed so that the doctor can examine the back of the eye more carefully. This is important in patients with diseases that may affect the eye. If congenital cataracts are present in both eyes, only one eye at a time should be operated on. Healing occurs in the first eye before the second congenital cataract is removed, sometimes as early as the following week. A final eyeglass prescription is usually given about four to six weeks after surgery. Patients will still need reading glasses. The overall health of the patient needs to be considered in making the decision to operate. However, age alone need not preclude effective surgical treatment of congenital cataracts. People in their 90s can have successful return of vision after congenital cataract surgery.

Surgery to remove congenital cataracts is generally an outpatient procedure. A local anesthetic is used and the procedure lasts about an hour. Removal of the cloudy lens can be done by several different procedures. The three types of congenital cataract surgery available are:

• Extracapsular congenital cataract extraction. This type of congenital cataract extraction is the most common. The lens and the front portion of the capsule are removed. The back part of the capsule remains, providing strength to the eye.
• Intracapsular congenital cataract extraction. The lens and the entire capsule are removed. This method carries an increased risk for detachment of the retina and swelling after surgery. It is rarely used.
• Phacoemulsification. This type of extracapsular extraction needs a very small incision, resulting in faster healing. Ultrasonic vibration is applied to the lens to break it up into very small pieces which are then aspirated out of the eye with suction by the ophthalmologist.

A replacement lens is usually inserted at the time of the surgery. A plastic artificial lens called an intraocular lens (IOL) is placed in the remaining posterior lens capsule of the eye. When the intracapsular extraction method is used, an IOL may be clipped onto the iris. Contact lenses and congenital cataract glasses (aphakic lenses) are prescribed if an IOL was not inserted. A folding IOL is used when phacoemulsification is performed to accommodate the small incision.

Antibiotic drops to prevent infection and steroids to reduce inflammation are prescribed after surgery. An eye shield or glasses during the day will protect the eye from injury while it heals. During the night, an eye shield is worn. The patient returns to the doctor the day after surgery for assessment, with several follow-up visits over the next two months to monitor the healing process.